Contrast-enhanced mammography (CEM) is gaining clinical traction as a cost-effective imaging technique with diagnostic performance comparable to MRI. Since its commercial debut in 2011, global uptake has increased, yet reimbursement mechanisms remain fragmented and inconsistent. An international survey among CEM expert centres highlights this disparity, revealing that although many institutions have adopted CEM for clinical use, they continue to encounter challenges related to reimbursement strategies, coding and institutional funding.
Global Disparities in Reimbursement
Among the 20 expert centres surveyed across Europe, North and South America, Asia and Oceania, 60% reported receiving reimbursement for CEM, while 40% did not. The reasons for non-reimbursement included the absence of specific billing codes, lack of insurance or healthcare system coverage, or internal coverage through departmental budgets. Even among those receiving reimbursement, there was no uniformity. Only two-thirds of these institutions reported full reimbursement for all components of CEM, such as mammography, contrast medium and intravenous injection. Indication-based reimbursement also varied. Some institutions reported coverage limited to clinical use, excluding screening or research.
Must Read: Cost-effective MRI Alternative for BI-RADS 4 Lesions
Sources of reimbursement differed according to hospital type. Public and university-affiliated hospitals were mainly reimbursed through national healthcare systems, though some also relied on research grants or patient insurance. In contrast, private hospitals generally relied on direct patient payments and insurance. The absence of dedicated billing codes emerged as a critical barrier. Most institutions used alternative codes originally intended for full-field digital mammography or tomosynthesis, while only a minority had specific national declaration codes.
Cost Differences and Implications
CEM remains more affordable than breast MRI across almost all surveyed centres. Most CEM procedures were priced below 200€, while MRI costs commonly exceeded that range, sometimes by a margin of more than 700€. Despite the cost advantage, CEM adoption has not been significantly influenced by reimbursement availability in the majority of centres. Nevertheless, nearly half of respondents reported reimbursement-related challenges, such as incomplete coverage of procedural components, delays in approval processes and lack of insurer engagement.
The lack of dedicated codes for contrast media and injection procedures further complicates billing. Over 90% of respondents did not use separate codes for intravenous injection, and 60% lacked codes for the contrast medium itself. Even among those without national codes, the majority were aware of ongoing efforts to establish formal coding structures. Countries such as Australia, Argentina, Brazil, the Netherlands, Spain and the USA were noted for such initiatives.
Calls for Policy Change and Professional Advocacy
Participants identified several areas for improvement. Standardised national billing codes for all components of CEM, including dedicated codes for CEM-guided biopsies, were seen as necessary to ensure appropriate reimbursement. Recognition of CEM by scientific societies and public healthcare systems was also recommended. Respondents advocated for collaborative efforts between radiologists, professional organisations and policy bodies to push for structured reimbursement systems.
Misinterpretations of reimbursement status also revealed gaps in radiologists’ awareness of financial processes, with several participants initially reporting no reimbursement despite institutional budget coverage or the use of existing mammography codes. These findings point to the importance of increased education around reimbursement practices and the need for clear, standardised policies to support broader adoption.
Contrast-enhanced mammography continues to expand globally, supported by its clinical effectiveness and lower cost relative to MRI. Yet inconsistent reimbursement strategies and coding limitations present challenges for its full integration into routine care. Most surveyed institutions have adopted alternative methods to ensure coverage, but the lack of dedicated national reimbursement codes remains a persistent barrier. Efforts to formalise billing practices, enhance policy recognition and advocate for inclusive reimbursement models will be essential for supporting wider adoption of this valuable imaging tool.
Source: European Journal of Radiology
Image Credit: iStock
